Spenshult Hospital

Osteocalcin is a metabolic active hormone, which correlates positively with bone formation and inversely with body mass index and waist circumference in adults. To investigate whether osteocalcin in infancy and early childhood were related to childhood growth or body composition. A Swedish longitudinal birth cohort with blood samples from 551 children from birth until 5 years of age. Regular anthropometric measurements were carried out up to 8 years of age and dual-energy X-ray absorptiometry (DXA) scans were also performed at 8 years. The results included p-values and Spearman's rho (ρ). Osteocalcin at 4 months of age correlated inversely and consecutively with weight from 4 to 24 months and to waist circumference from 6 to 24 months in boys. The correlations for girls were limited to weight at 4 months and waist circumference at 6 and 18 months (ρ < 0.3, p = 0.001 to 0.048). The boys' osteocalcin levels at 5 years correlated positively with their height and weight at 5 and 6.5 years (ρ < 0.3, p < 0.01). Meanwhile, the girls' osteocalcin at 3 years showed positive correlations to all weight and height measurements until 8 years of age (ρ < 0.3, p = 0.003 to 0.023). DXA data showed that the boys' osteocalcin at 5 years correlated with the fat-free mass index (FFMI) (ρ 0.212, p = 0.026) but not the fat mass index (FMI) at 8 years. The opposite was seen for the girls' osteocalcin at 3 years, which correlated with FMI (ρ 0.222, p = 0.020) but not FFMI. Early levels of osteocalcin showed inverse correlations with later weight, height and body composition in infancy and positive correlations during childhood. The weak but consistent correlations suggest that osteocalcin carries information about future growth. Girls with high osteocalcin at 3 and 5 years had a larger fat mass at 8 years, while boys, in contrast, had a larger lean mass. These sex differences need to be further explored.

BackgroundRheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease, that influences patients’ health in different ways, including physical, social, emotional, and psychological aspects. The goal of rheumatology care is to achieve optimal health and personalised care and therefore, it is essential to understand what health means for patients in the early course of RA. The aim of this study was to describe the understanding of health among patients with early RA.MethodsThe study had a descriptive qualitative design with a phenomenographic approach. Phenomenography is used to analyse, describe, and understand various ways people understand or experience a phenomenon, in this study, patients’ understandings of health. Individual semi-structured interviews were conducted with 31 patients (22 women and nine men, aged (38–80) with early RA, defined as a disease duration of < 1 year, and disease-modifying anti-rheumatic drugs (DMARDs) for 3–7 months. The phenomenographic analysis was conducted in 7 steps, and the outcome space presents the variation in understanding and the interrelation among categories. In accordance with the European Alliance of Associations for Rheumatology’s (EULAR) recommendations, a patient research partner participated in all phases of the study.ResultsThe analysis revealed four main descriptive categories: ‘Health as belonging’ was described as experiencing a sense of coherence. ‘Health as happiness’ was understood as feeling joy in everyday life. ‘Health as freedom’ was understood as feeling independent. ‘Health as empowerment’ was understood as feeling capable. Essential health aspects in early RA are comprised of a sense of coherence, joy, independence, and the capability to manage everyday life.ConclusionsThis study revealed that patients’ perception of health in early RA encompasses various facets, including a sense of belonging, happiness, freedom, and empowerment. It highlighted that health is multifaceted and personal, emphasizing the importance of acknowledging this diversity in providing person-centred care. The findings can guide healthcare professionals to deepen patients’ participation in treatment goals, which may lead to better treatment adherence and health outcomes.

BackgroundIn accordance with the EULAR recommendations, the Danish Hospital for Rheumatic Diseases have systematically invited patients with rheumatoid arthritis (RA) to cardiovascular (CV) risk assessment since 2011. Patients with high risk are invited to a follow-up screening after one year. To optimize the screening and tailor it to individual needs, information about who accepts vs. declines follow-up is needed. Thus, the aim of this study was to explore participation in systematic CV risk assessment among patients with RA. Furthermore, to explore differences between patients with low vs. high risk, and between patients with high risk who accept vs. decline follow-up.MethodsData from 2,222 outpatients with RA in the period 2011-2021 were retrieved, and of these 1,522 were under 75 years and eligible to be invited. To assess the 10-year risk for CV death, the modified Systematic Coronary Risk Evaluation (mSCORE), derived by multiplying the SCORE by 1.5, was used. Logistic regression analyses were used to explore differences in CV risk factors (triglycerides, HbA1c, lifestyle factors) and measures of disease impact (pain, fatigue, patient global assessment, HAQ, EQ-5D-5L) between patients with low vs. high risk. Differences between high risk patients who accepted vs. declined follow-up were analysed using Wilcoxon rank sum test and chi-squared test for groups.ResultsOne thousand one hundred forty-nine received a CV screening invitation and 91 declined participation. Patients with high risk had significantly longer disease duration (OR; 95 CI) (1.017; 1.002-1.032), higher levels of triglycerides (1.834; 1.475-2.280), HbA1C (1.046; 1.020-1.070), pain (1.006; 1.001-1.012), and HAQ-score (1.305; 1.057-1.612) compared to patients with low risk and they more often declined follow-up (43% vs. 28%, p < 0.001). Those who declined a follow-up invitation were older (p = 0.016) and had shorter disease duration (p = 0.006) compared to those who accepted follow-up.ConclusionA first CV screening consultation was accepted by most patients with RA, while only every other patient with high to very high CV risk adhered to a follow-up screening consultation. Neither measures of disease impact nor lifestyle factors were associated with adherence. Further studies are needed to explore the patients' motivation, barriers and facilitators for adherence or non-adherence to a follow-up consultation.

BackgroundInvolvement of B cells in the pathogenesis of rheumatoid arthritis (RA) is supported by the presence of disease-specific autoantibodies and the efficacy of treatment directed against B cells. B cells that express low levels of or lack the B cell receptor (BCR) co-receptor CD21, CD21−/low B cells, have been linked to autoimmune diseases, including RA. In this study, we characterized the CD21+ and CD21−/low B cell subsets in newly diagnosed, early RA (eRA) patients and investigated whether any of the B cell subsets were associated with autoantibody status, disease activity and/or joint destruction.MethodsSeventy-six eRA patients and 28 age- and sex-matched healthy donors were recruited. Multiple clinical parameters were assessed, including disease activity and radiographic joint destruction. B cell subsets were analysed in peripheral blood (PB) and synovial fluid (SF) using flow cytometry.ResultsCompared to healthy donors, the eRA patients displayed an elevated frequency of naïve CD21+ B cells in PB. Amongst memory B cells, eRA patients had lower frequencies of the CD21+CD27+ subsets and CD21−/low CD27+IgD+ subset. The only B cell subset found to associate with clinical factors was the CD21−/low double-negative (DN, CD27−IgD−) cell population, linked with the joint space narrowing score, i.e. cartilage destruction. Moreover, in SF from patients with established RA, the CD21−/low DN B cells were expanded and these cells expressed receptor activator of the nuclear factor κB ligand (RANKL).ConclusionsCartilage destruction in eRA patients was associated with an expanded proportion of CD21−/low DN B cells in PB. The subset was also expanded in SF from established RA patients and expressed RANKL. Taken together, our results suggest a role for CD21−/low DN in RA pathogenesis.

BackgroundLong-term gout management is based on reducing serum urate by using urate-lowering therapy (ULT) [1, 2]. A lifelong treat-to-target approach is advocated, though a ULT (taper to) stop attempt can be considered (treat-to-avoid symptoms approach) during remission[1]. It is yet unclear if either is a superior strategy when remission has been achieved. Exploring gout patients’ beliefs on these long-term ULT strategies is important for optimising gout management.ObjectivesTo identify factors that influence the decision for continuation (treat-to-target) or discontinuation (treat-to-avoid symptoms) of ULT and to determine their perceived relative importance in gout patients in remission.MethodsA mixed methods design was used. First, semi-structured interviews (substudy 1 EULAR POS1477 2020) were held to identify barriers and facilitators for continuation and discontinuation of ULT using inductive thematic analysis. These items were then summarized by a multidisciplinary team (including a patient partner) in neutrally formulated items. These items were subsequently used in a Maximum Difference Scaling study (MaxDiff, substudy 2) to rank them and to determine their relative importance based on utility scores (preference score). A rescaled probability score (RPS) was generated with a 0-100 range (the higher the score, the more important the item). For example, an item with an RPS of 8 is twice as important as an item with an RPS of 4. Patients of both studies were recruited from general practitioners and from the rheumatology department of the Sint Maartenskliniek (both in the Netherlands). The semi-structurered interviews as well as the MaxDiff experiment have been pilot tested.ResultsSubstudy 1 and 2 included 18 and 156 patients, respectively (see Table 1). The semi-structured interviews yielded 46 barriers/ facilitators and were summarized in 22 items, divided into 10 overarching themes (logistics, lifestyle, role of serum urate, physician role, scientific knowledge, general medication use, anti-inflammatory use, gout flares, ULT use and long-term gout effects). Figure 1 shows their ranking (substudy 2). The ‘risk of joint damage’ (RPS 8.77) was the most important item, and is 26 times more important than the least important item, ‘cost of my gout treatment’ (RPS 0.34).ConclusionIn particular, items concerning (control of) disease activity (flares, joint damage) play a role when gout patients in remission consider (dis)continuation of ULT. Costs, logistics and monitoring by physician were deemed less important. These results provide a basis for shared decision making between physicians and patients, and show which items should at least be discussed when considering ULT (dis)continuation in the remission phase.

Psychosocial resources, psychological and social factors like self-efficacy and social support have been suggested as important assets for individuals with chronic pain, but the importance of psychosocial resources for the development of pain is sparsely examined, especially sex and gender differences. The aim of this study was to investigate associations between psychosocial resources and sex on the development of frequent pain in a general population sample, and to deepen the knowledge about sex and gender patterns. A sample from the Swedish Health Assets Project, a longitudinal cohort study, included self-reported data from 2263 participants, 53% women, with no frequent pain at baseline. The outcome variable was frequent pain at 18-months follow-up. Psychosocial resources studied were general self-efficacy, instrumental and emotional social support. Log binomial regressions in a generalised linear model were used to calculate risk ratios (RRs), comparing all combinations of men with high psychosocial resources, men with low psychosocial resources, women with high psychosocial resources and women with low psychosocial resources. Women with low psychosocial resources had higher risk of frequent pain at follow-up compared to men with high resources: general self-efficacy RR 1.82, instrumental social support RR 2.33 and emotional social support RR 1.94. Instrumental social support was the most important protective resource for women, emotional social support was the most important one for men. Results were discussed in terms of gender norms. The psychosocial resources general self-efficacy, instrumental and emotional support predicted the risk of developing frequent pain differently among and between men and women in a general population sample. The results showed the importance of studying sex and gender differences in psychological and not least social predictors for pain.

The COVID-19 pandemic has affected the health and lifestyles of both the general population and of vulnerable groups. Individuals with knee pain are recommended to lead an active lifestyle to relieve pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function, and a diminished quality of life. This study aimed to explore experiences of how health and lifestyle among individuals with knee pain have been influenced during the COVID-19 pandemic. Interviews (n = 19) were conducted in 2021 and analysed with qualitative content analysis. The results showed how individuals with knee pain adjusted their behaviour and revalued their life to maintain health and lifestyle during COVID-19. Adjusted behaviours emerged, such as spending more time at home, becoming digital, and spending more time outdoors, while revaluing life emerged as having a positive outlook on life and sharing responsibility. In conclusion, behaviour was adjusted, and life revalued to manage health and lifestyle during the pandemic. However, the findings are probably similar to the general population, i.e., individuals with knee pain live similar lives as the general population despite knee pain. The results may contribute to alternative ways of maintaining health and lifestyle in various vulnerable groups and may be applied in situations other than the pandemic.

BackgroundChronic widespread pain (CWP) has been suggested as a risk for mortality in especially cardiovascular diseases and malignancies (1, 2). Most studies are based on the CWP definition that is part of ACR1990 criteria for fibromyalgia (3). The ACR1990 definition has been criticized for being too including, and recently a more stringent definition, the WP2019, has been suggested (4). It is yet to be investigated how the more stringent WP2019 definition compares to the ACR1990 definition regarding excessed mortality and certain causes of death.ObjectivesTo study if overall mortality and common causes of death are increased among people with CWP in a 25 year follow up of a cohort from the general population. Additionally, to study if the definition of CWP, according to ACR1990 or WP2019, influences these outcomes.MethodsA 25-year follow up of the EPIPAIN cohort study that in 1995 included 2425 person from the general population (5). They were at baseline divided into three pain groups: CWP, chronic regional pain (CRP) and no chronic pain (NCP). CWP was defined according to both the ACR1990 (CWPACR1990) and the more stringent WP2019 (CWPWP2019) criteria. Deaths and causes of death were derived from the official national Swedish register. Mortality, adjusted for age, sex, socioeconomic status, and smoking habits, was analyzed with Cox regression and presented as Hazard Ratios (HR).ResultsAn overall increased mortality was predicted by CWPWP2019 (HR 1.32, p = 0.033), but not by CWPACR1990 (HR 1.08, p = 0.484), compared to NCP. An increased mortality in diseases of the circulatory system was predicted by CWPWP2019 (HR 1.70, p= 0.016), but not by CWPACR1990 (HR 1.35, p=0.128). Neither definition of CWP, CWPWP2019 (HR 1.35, p= 0.176) or CWPACR1990 (HR 1.21, p=0.327) predicted a significantly increased mortality for neoplastic diseases overall.ConclusionThe WP2019 definition of CWP enhanced the association between CWP and increased mortality, and especially mortality in diseases of the circulatory system. This suggests that the CWPWP2019 definition captures a more vulnerable subset of the population that should be assessed for other cardiovascular risk factors in the clinic.